title: Outcome of cervical intraepithelial neoplasia 2 diagnosed by punch biopsy in 131 women.
abstract: OBJECTIVE
  To study the outcome of biopsy-diagnosed cervical intraepithelial neoplasia (CIN) 2 in patients treated by loop electrosurgical excision procedure (LEEP) or cold knife cone biopsy (CKC).
  
  
  METHODS
  Patients (n = 131) were analyzed for histological results on LEEP/CKC specimen. Demographic and risk factors, referral cytology, high risk human papilloma virus (HR HPV) test and follow-up colposcopic clinic visits were studied.
  
  
  RESULTS
  Excisional specimens from LEEP/CKC demonstrated no CIN in 20 (15%), CIN 1 in 17 (13%), CIN 2 in 57 (44%) and CIN 3 in 37 (28%). No invasive cancers were identified. The referral Pap smear was high grade or possible high grade in 52 (40%), low grade in 59 (45%) and inconclusive in 20 (15%). Fourteen patients (11%) had positive excisional margins, eight of the 14 were tested for HR HPV infection before LEEP, and all were positive. Post-treatment HPV testing was performed at the 12-month visit in 6 of the 14 patients who had positive excision margins, and all 6 tested were negative. Two women (1.5%) with clear margins had recurrence of CIN 2, both tested positive for HR HPV after treatment.
  
  
  CONCLUSIONS
  Our data showed that a significant number of women (28%) with biopsy-diagnosed CIN 2 had CIN 1 or no dysplasia on subsequent excisional biopsy. The recurrence risk of high grade dysplasia in CIN 2 is low (1.5%). However, due to the high number of patients (72%) with high grade dysplasia at treatment biopsy, caution needs to be exercised when a conservative approach is adopted in the management of CIN 2.
authors.affiliation: Sydney Gynaecologic Oncology Group, Sydney Cancer Centre, Sydney, New South Wales, Australia. zongqunding@gmail.com
authors.forename: Zongqun
authors.initials: Z
authors.lastname: Ding
authors.forename: Chunping
authors.initials: C
authors.lastname: Jiang
authors.forename: Timothy
authors.initials: T
authors.lastname: Shore
authors.forename: Selvan
authors.initials: S
authors.lastname: Pather
authors.forename: Christopher
authors.initials: C
authors.lastname: Dalrymple
authors.forename: Kenneth
authors.initials: K
authors.lastname: Atkinson
authors.forename: Rajmohan
authors.initials: R
authors.lastname: Murali
authors.forename: Ehab Salem Yousef
authors.initials: ES
authors.lastname: Al-Rayyan
authors.forename: Kehui
authors.initials: K
authors.lastname: Luo
authors.forename: Jonathan
authors.initials: J
authors.lastname: Carter
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy / Q000379:methods; D005260:Female; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000517:prevention & control / Q000628:therapy; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000473:pathology / Q000517:prevention & control / Q000628:therapy